This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Wednesday, 12 March 2008

Protected Meal Times: What a Fucking Joke

We all know that frail elderly patients are becoming increasingly malnourished in hospital. We all know that their trays get left out of reach, that no one comes to assist them with their meals. We all understand that it is the JOB of the registered nurses to ensure that nutrional needs of patients are met. The registered nurses understand this better than everyone. We even understand it better than those of you who accuse the nurses of not wanting to be "bothered" feeding patients. Fucking simpletons.

Good nutrition is vital. People who have inadequate intake of diet and fluid do not get better. They deteriorate. They are at risk of impaired skin integrity. Wounds do not not heal as well when one is malnourished. I have seen renal failure, electrolyte imbalances, dry cracked painful lips, mouths and tongues on elderly people who are not given drinks. They are so confused that they often pull out their IV cannulas making hydration via IV fluids impossible. I have seen frail
elderly people get even skinnier in hospital to the point that they appear to be skin and bones. Pressure sores form. You can see muscles and bone as the sore is so deep. The become more disorientated. Renal failure courtesy of dehydration. They suffer. It sucks. It should never happen yet it frequently does.

We are constantly interrupted every thirty seconds during mealtimes. Everyone from relatives to pharmacy to doctors to physio does this. The registered nurses at my facility all got together and got on management's case. We pushed for protected meal times. We fought hard. Let's take the evening meal for example: At 6PM the domestics bring the food trolley out and it is the job of the nurses along with the help of the care assistants to get dinner served to every single patient. There are 25 patients and because we are a medical ward that has a high number of elderly patients most of our people are either too sick to feed themselves or too confused to just too old. Usually we have anywhere between 8 and 20 people who are identified as feeds. Each patient takes about 20 minutes to feed. Some are faster and some are slower but we will work with the average. Many have no appetite.

If I take 2 patients that is 40 minutes down. The other nurse takes 2 patients and that is 40 minutes down. The first HCA takes 2 patients and that is 40 minutes down. The other HCA tries to feed 2 but also tries and manage all the people asking for the toilet, ringing the bell during this time. There are 2 Registered nurses and 2 care assistants for 25 patients IF WE ARE LUCKY.

That means that the best case scenario is that 40 minutes after the trays have been dropped onto the bedside table only 6 people have been fed and the rest have had trays sat in front of them going cold for 40 minutes while they stared at it. And remember that the phone is ringing off the hook at this time and we have no ward clerk. Remember that pharmacy is showing up with controlled drugs and demanding that a Nurse instantly stop what she is doing to check those narcotics in....god forbid if the precious pharmacist gets delayed or GASP has to do it herself.

The example I wrote above is best case scenario. It really is. But the reality is this: People will become extremely unwell around mealtime unexpectedly causing me to have to haul some serious ass and stay focused on them in order to carry out the doctors orders and not harm them. If that situation occurs the doctor is going to have a shit fit if I leave him and his patient to run off and feed people. That leaves 2-3 to try and cope with all the feeds, and everything else.

The phone rings non stop during mealtimes. Non-fucking stop. We can thank the relatives for that as they get 5 people to ring for the same patient every hour. If you ask them to get one person to ring once day in order to minimize the nurses having to spend all shift running to the phone every 2 minutes they become nasty, abusive and most of all paranoid....accusing us of not wanting to share information. They also like to spend ages giving their dysfunctional family history i.e. "5 different people have to ring because so and so doesn't speak to so and so".

Ringing a ward during mealtimes when your loved one is stable and you have already rung 5 times during the day is very disruptive. The phone is a hell of a long walk away from the patients and the food trolley. I no sooner put the phone down and start the trek back up to my patient before the damn thing rings again. You have no idea how many problems we have with this. No goddamn wonder they have trays out of reach and food gets cold. If the patient is frail and confused we may leave the tray out of reach whilst hoping to get back and feed him in good time. Leave the tray where he can get it and he will choke himself and throw it onto the floor. We have to hand all the trays out before we can go back and feed. Have to. Without interruptions this takes 25 minutes. With all the usual interruptions it takes longer.

I can ignore the phone and try to carry on but the last time I did that management got a complaint from a relative about us not answering the phone for an hour and we got a disciplinary. No they won't fucking pay for a ward clark to be sat there on an evening answering the phone.

The other day the daughter of one of the 30 patients rang and demanded to speak to the Nurse immediately. I was trying to feed 3 patients at the time as well as monitor a patient with a head injury. She demanded that I come to the phone even though the HCA told her it was mealtime. She scared the HCA. I came to the phone. The woman wanted to me to answer 101 stupid questions and tried to keep me on the phone. I told her that I was trying to take care of patients and that it was mealtime it would be best if she rang back later. "How dare you, I have an appointment later and it would be very inconvienant for me to ring later" she said. I often tell my friends and family that you are in more danger from you Nurse's other patients' relatives than you are from a bad nurse or doctor. I managed to get off the phone with this bitch and when I got back down the ward my head injury patient was on the floor again.

One of the ways I try and sort this is I really start moving my ass at 4PM...or as soon as I finish sorting out all the things that should have been done during the day. If I have been lucky I have sorted out all the day shift problems by that time. It is a losing battle but I try.

I try and knock out every med /IV and otherwise that is due between 4:30 PM and 6:30 PM. There are tons of them each with a problem. Half the time the stuff isn't there and I have to leave my patients to leg it to pharmacy.

I also spend that hour and the half giving pain meds to anyway known to have pain. I ask everyone if they need anything. We try and get everyone toileted. We try to turn and reposition and clean everyone who needs it. I try to do a quick assessment of all my patients (usually about 14)to head off any problems that may rear it's ugly head at meal time. I try to ignore all the interruptions in order to do this and I pray that I will be able to focus on meals when that trolley shows up at 6PM. But relatives and non ward staff piss and moan when they walk onto a ward and interrupt a Nurse and she doesn't drop what she is doing immediately to service their non essential problem. What I am trying to accomplish is impossible but it doesn't stop us from trying. I just want to be able to focus on feeding patients. We all do.

So 6 PM rolls around, the domestic arrives with the food trolley and I don my lovely pinny and start getting trays out. Never mind that I have critically ill patients who need their meds. I did them an hour ago but they want more. We identify the patients who need help with coloured trays, but we already know anyway. I keep an eye on the health care assistants to ensure that they are bringing pureed diets to people with swallowing problems so that they don't choke to death etc etc. I make sure that the diabetics get a diabetic meal. I try to feed people. We run down to the kitchen getting stuff that patients want that are not on the food trolley.

Now despite that fact that we busted ass from 4PM to 6PM trying to sort everyone out, that wall now is lit up with call lights ringing. Absolutely lit up. We can keep trying to feed or we can answer the bells. I will try and send one care assistant off to get all of the bells while the 3 of us try and feed. Most people are ringing for things like an extra pillow or a blanket. Things they didn't think of before. Many of them are elderly and confused and to be honest they just forgot that someone already walked them to the toilet 20 minutes ago, or they need to go again because the good old bladder just ain't what she used to be. But man will they hit the ceiling and complain if they wait awhile for the nurse to come. Family members who rang at 4:30 ring back again to answer the same dumb questions. For the love of god we have no idea when the doctor is coming, when discharge will happen, when pharmacy will bring those meds or when the ambulance will come. FOR THE LOVE OF CHRIST THERE IS NO WAY FOR THE NURSES TO KNOW THESE THINGS.

The phone is ringing non fucking stop. I am ignoring it even if it means trouble later. I am determined to feed these people.
Five minutes after the domestic brought the trolley out the lady in bed 3 has had a bowel motion in bed and due to her dementia has spread it everywhere. This is a 4 time a day event with this poor lady. She is bedbound and weighs about 19 stone. Would you like the 4 of us (and it will take all 4) to take 20 minutes/probably more to clean her up and then go back to feeding? Or would you like me to leave her like that until I finish feeding the others? Who is feeding the patients whilst the 4 of us are trying to maintain the dignity of the lady who has had the accident? No one. The trays are going cold and the domestic will collect them back in. The bitch.

Oh oh. I do need to answer the phone at 6:10 because the sound of the ring tells me it is an internal call. It is pathology lab. The lady in bed 10 came in this afternoon and had blood taken. She looks like hell. But there is no obvious sign of bleeding. I haven't wanted to leave her side. She has an HB of 5 they say. Look it up. She'll die if I do not get a doc down now to assess her and probably order some blood. She needs obs doing, and tests etc. Then I have to go through a long and complex and time consuming process to get the blood and get it hung. If that was your mum would you want me waiting on that for another hour plus or so while I attempt to feed? Tell me what you think. She needs to be escorted off the ward for a test by a member of the ward staff. The endoscopy department does not care that this leaves 2 or 3 of us to do all these feeds. if we don't send an escort, they won't do the life saving diagnostic test. Now there are 2- 3 of us.

At 6:15 my cancer patient who is dying rings to say that the pain meds she has had isn't helping and you can tell by looking at her that the poor women is in excrutiating pain. It is safe for her to have some oramorph now. I will get it for her simultaneously with sorting the blood for the other woman. But what about the trays going cold?

The oramorph is a controlled drug. Two nurses have to go through a long and time consuming process in order to be able to access that medicine and give it to her. I will not make her wait. Fuck you for asking me too. I had to pull the other RN away from feeding a patient in order to access the oramorph (morphine). There is no way to access it without 2 registered nurses. Now one care assistant is trying to do all the feeds, the food is going cold and the domestic collects them back in.

But what is the most fucked up part about mealtime? Is it the fact that the domestics are on a tight time scale and will run down the ward collecting all the meals back at 6:30 whether they have been eaten or not? Is it the fact that the relatives will show up at 6:30 with venom shooting out of every pore of their being screaming at me wanting to know why grandpa has a cold, untouched tray in front of him?

No the most fucked up thing at meal time is the goddamn doctors. I look after 14 patients with 8 different doctors and they LOVE to show up at mealtime to do a ward round and demand that the nurse drop what she is doing and follow them around for a half an hour. The bastards do it every fucking mealtime. I hate them. When the nurses asked for protected meal times we begged the docs to try and do their rounds outside of mealtime. The response was that their ward round will get done when it is convienant for them, not the nurses. They also laughed right out loud at us for asking. And you can bet your ass that on every single mealtime we are sure to have 2 or 3 consultant doctors show up to do rounds. Remember that best case scenario I wrote about above? The one where we can at least get 6 people fed in 40 minutes if all hands are on deck. You can fucking forget it thanks to the docs. I can refuse to attend their ward round and keep on feeding. But it means getting screamed at in front of all the patients and a complaint about me going into management.

Whether we have 6 people who need to be fed or 16, the number of staff DOES NOT alter. We get 2 nurses and 2 healthcare assistants no matter what. If I get a contracter into my house to do some work, and it looks like the job is bigger than he anticipated he gets more staff. If a nursery takes more children than the normal numbers on any given day they get more staff. A hair salon has more staff in on their busiest days. This does not happen in nursing.

So I open the newspaper and I see comments galore accusing the nurses of not caring about feeding patients. They suggest coloured trays to identify vulnerable patients....as if we are too stupid to know. They all look the other way when the hospitals get rid of nurses and refuse to hire nurses. The coloured trays don't do shit. They don't help at all. You can take your coloured trays and shove them you your asses. Please help us instead of making things worse.

So we begged management for protected mealtimes. We begged them to help us tell the public not to ring at this time. We begged the docs to not do ward rounds at this time if they can help it. We asked a higher power to not allow anyone to crash or become extremely unwell, especially during meal times. We begged management to allow us to increase our numbers. We begged the domestics to not collect the damn meals in so quickly when we haven't had a chance to feed.

Their collective response has all pretty much been : Fuck you Nurse. Fuck you.

Thanks a lot for your fucking support.

The nurses will keep on trucking but if they only bit of help we get is a goddamn coloured tray...then I just don't see things improving.

Wow! What a post. It should be compulsory reading for all hospital managers and doctors. When I was nursing (eons ago) we used to ask family members to come and feed their poorly relatives and the response was never good - after all, it was 'our job'.

More power to your elbow - dont give up the struggle for protected mealtimes.

Wonderful, wonderful post. Although fucking shite, if you know what I mean. Don't suppose you work at Addenbrookes in Cambridge (Sorry, Cambridge University Hospitals Fucking Foundation Fucking Trust) do you? This 'world leading' shithole may even by marginally worse than you describe. In medical of course. Stupid fucking me for thinking 'it needs people who care'. Nearly killed me.

Excellent post. I'm a consultant geriatrician. Have managed to get protected mealtimes only on one of my two wards. I stop my ward round and leave at mealtimes and come back 45 mins later. Some of us doctors do realise how busy you are, mine are completely run off their feet. I don't ask a nurse to accompany me on my ward round, I'd rather they gave painkillers/morphine to patients in pain etc. I take the Kardex with me instead and then personally update the nurse in charge of the bay as I complete each bay. And I try to give every patient a drink on my ward round.

So true, I am a health care assistant and student nurse and this seems a major problem to me. It is so frustrating that you try to do your best for the patients but their are always staff shortages, interuptuions and that BLOODY phone! you should get this published in a nursing journal, At least I now know i'm not alone in these feelings. we can try as hard as we can to implement policies, legistation and protocol but they are not realistic goals. I would love for the fat cats to get off their arses and actually come down to shop floor level and work for a living!!!! I have come across doctors who have taken patients food away whilst eating to assess them; this is not acceptable behaviour. The doctor thought the protective meal times only applied to visitors not doctors!! how very egotistical!!!!!!!! she stood their and argued with me while the elderly malnourished patient sat with his tray out of reach because she had moved it away. The cheek of it! so much for patient dignity and protection eh!

This action prompted a meeting between the ward manger and consultant and medical team. But is still a problem. WE NEED MORE STAFF!!!!!!

You MUST send a copy of this to all the major Newspapers! I am out of nursing now but that is how it was than and how it still is and how it will continue unless those who can fix it are made to listen. Get it into print NOW.

It's worse now with the increased patient acuity and through put. The phone doesn't stop at mealtimes and 7/10 it is management demanding that we identify patients to move out so that we can take more admissions that we cannot handle. If you do anything other than pander to them and their obsession with beds, targets etc there is hell to pay.

A lot of this seems to come down to the outsourcing of meals from what you say. As an ex-medium term patient (3 months) I can see exactly where you are coming from food wise (even with the PR stunt of that half-American guy) hospitals are dreadful for nutrition. Plus the 'god' complex of many doctors. I'm sure not all of the patients' families are as bad as your examples but I've certainly seen my share of apalling behaviour by some relatives. One thing I noticed was how hard the nurses were worked and the ridiculous expectations placed upon them. I even sympathised with the nurse who tried to get me to read Jehovahs Witnesses pamphlets. Apart from this she was a nice, hard-working and competent professional.The nurses who did not come up to the usual expected standards of concern and sympathy seemed to be burned out by a system that has been taking advantage of their 'carer' role for far too long. I just hope I die in a car accident at the age of 75.

I think they can prop up their own points, specially if they are mentioning the integrity topic, I've been reading this article and I also have seen the frail about all this, I mustn't forget the main point.

Thanks so much for your post. I used to work as a hospital telephonist, but that was nowhere near as stressful as what you have just described. Oh yes, and we WEREN'T ALLOWED to put calls through to the wards during meal-times!!

This post is a revelation. I'm going to raise your points with my local hospitals trust, and see what they have to say. I work for a LINk - you probably view us as pretty powerless, but I'd rather try to make things better than not try at all.

anon.we have protected meals times, and would enforce it. however this means we then have to do all our own bloods as the phlebotomy team will not return to ward, patients miss their physio,and being seen by specialists nurses, and try enforcing no visitors rule !!. if they helped I wouldn,t mind by usually its to interfere with every other patient and update their relatives on our uncaring attitude !. worst of all is six inches of snow on the ground, and the patient experience matron asking if we were making sure our patients were given a biscuit withe their drinks. . .i,d say roll up your sleeves and try hands on caring !!

Not a nurse, and agree with a lot of this, and have had very ill relatives in hospital. One died there last year. A shame you seem to view relatives as mainly stupid and deliberately obstructive. Someare. But the reason many want a lot of contact is precisely because they can see clearly how frail the system is that their loved ones depend on, and are not confident it works.

My daughter is an HCA working with elderly patients, she echoes your concerns and has tried to raise them with her managers. Despite all this she loves her job and was due to start her nursing training in September - she has now been told she will have to pay full fees, as a young mother on minimum wage this is clearly not possible. Another good nurse bites the dust!

From reading the comments I'm confused about one thing - why no visitors during protected meal times? Surely the visitors would be able to help feed, and make sure the patients actually get their food. Or do they end up getting in the way of the nurses?

An excellent, eye-opening post. It just makes me sad due to the funding cut s it is only going to get worse.

This needs to be posted everywhere. Not just traditional press. Stick it on Facebook, send it out on twitter, print it out and leave it in the doctors surgery or at your church or your mosque or your golf club or whatever. Just tell folk, and keep on telling them, because otherwise nobody will ever know since the papers don't print this kind of stuff.

I was alerted to your blog by a work colleague I am a nurse in elderly psychiatric care and understand the difficulties you have only too well. I had not fuly understood exactly what you are up against with the diva doctors etc. But have always defened us nurses case. I agree with an earlier comment you should send to a paper if only for us nurses to redress the huge issue here.

Been posting links to this blog all over the Internet today. It's fantastic and an entirely accurate description of the frustration and anger felt by frontline NHS staff trying to provide care for patients with inadequate resources. Am an A&E doc who resigned recently (after 20 years) following scandalous persecution after having repeatedly highlighted dangers and deficiencies in the services we try to provide. A lot of doctors are arseholes, and I hate them too, but the cause of the problem is inadequate resources and managers who don't give a flying fuck. Keep shouting. Good for you, I applaud you.

Excellent , At last , someone telling the truth . if you want this circulated I will happily do so . either / or to the press or onto every hospital ward in the country and then to the press with comments . thousands like you have here

I am a nurse but have become unwell and am disabled now . so have time on my hands to help

And whilst all this goes on on the ward the non medically trained managers are having a meeting to decide what nurses should be doing.There has always been 2 RGN and 2HCA on a shift the different now is their backup has gone.The dreaded matron or nursing officers who struck terror into the eyes of anyone (I mean anyone!) who dared interfer with patient care has gone.It used to be that patient visitors were vetted and drafted in at mealtimes to help feed patients - boy were they a wonderful lot. Doctors daren't be seen on a ward doing rounds at mealtimes - most of them had encountered the wrath of God descending on them from on high (well actually in the shape of a senior nurse who 'just happened' to appear from nowhere).Nurses have a talent of being able to juggle 7 things all at once - IF they have support from their senior nurses.

You go girl - shout as loud as you can - you speak for all of us. Me? after 30yrs I'm getting out - I don't do meetings and I don't want to sit round a desk with management who have no idea about people, just knowledge of business - patients are not products and never will be. I am a clinical nurse specialist - no space for me now in the NHS

Oh yes - the phone........You got 2 phone lines on your ward? Get a friendly person in works to make one an outside line - the other internal. It's amazing how that darn outside line lead to the socket gets detached during mealtimes!!!!!!!!

The matron of a hospital I trained at all those years ago said Nurses are the Eight Wonder of the World.You are one of them my friend.

Take heart - take care - and smile - today will be yesterday tomorrow.

Wow, what a post! I think this should be compulsory reading for the general public as well as hospital managers and doctors.

I got your link from the Traction Man's hospital food fight blog. I will promote you both everywhere I can...please keep blogging!

I recently had a stay in a ward where the average age was 70 - I am 26! So having my wits about my more than most I was able to observe the RN's and HCA's on the ward, and the difficulties faced by them, especially at meal times.

I'm a paediatrician and completely agree with you. Us docs do understand, but usually we have someone up our arses to get things done in unrealistic time frames too, and this sometimes mean we all end up pestering each other at the wrong time.

Interesting not many patients or visitor commenting here. I can see you are really angry and frustrated, and, as some one who spends a lot of time visiting a partner with on-going health problems who has required a lot of stays in hospital over many, many years we do realise that nurses are overworked and rushed off their feet. However, how much of this is really about meal times, and how much of it is about insufficient staffing all round - which means that things really are at breaking point by mealtimes?

Moreover, as one other person has already hinted, many patients and visitors have views on 'protected mealtimes' too and swear words could well come into it. A lot of visitors are horrified at seeing uneaten food whipped away too - food that they could have HELPED see that their loved one got some benefit from ... except that we are made to feel like some sort of vermin at meal times and often quite rudely excluded from the Ward. Last time I visited my partner he was woozy after coming round from an operation. After having not eaten all day he did not want the sandwiches he was given ... until, seeing he was dozing off again, I fetched us both something a bit better from the cafe and then we we were able a have little meal togther - like a normal civilised couple. (It was not an offical bloody P.M.T. so I was not cursorily thrown off the ward.) I watched one friend try to hold back the tears recently when she described how she was thrown off the ward rather than be allowed to eat with her husband who was dying of cancer. Eventually she was allowed to stay - and to help him eat, but only days before he died.

If visitors were allowed back in again to help we might get a bit of sanity into all of this.

Thankfully, I have not been an in-patient for a VERY long time but remember, on a medical ward, how hard it was for the nursing staff to do everything expected of them. That was in the old days of 'over-manning' but Matron, fire-breather that she usually was, stepped in to help where necessary and was far from afraid of getting her hands dirty or bloody. She led as much by example as by diktat. Doctors and Consultants alike quaked and fled at a glance but if a patient needed her care she exemplified the gentle caring and quiet competence she expected of those under her.

But even in those days of Matron, Ward Sisters, Staff Nurses, SRNs, SENs, Auxiliary Nurses, Student Nurses and Volunteers they were STILL over-stretched in trying to ensure that every patient was clean, fed and 'comfortable'.

Having also been a regular visitor for two very dear friends during their hospital stays more recently my admiration for nurses has increased even more. In the two very modern hospitals I found dedicated staff expected to handle far too many very ill, frail and confused patients with far too few staff - who do not seem to get meal times themselves, which is another thing most patients and relatives don't notice...

Swear as much as you like, Anne and colleagues. What is expected of you is fucking outrageous and I hope that my link to this blog via facebook gets you more support!

o.O Wow! Now I understand why the nurse asked me to feed my grandma when she was dying. I felt a bit unconfident at first, but of course I straight away found it was easy, and then I felt really glad that I was able to do something to help care for my beloved grandma before saying goodbye. I had no idea that you nurses are under such astonishing pressure, it sucks, and I'll post your link on my facebook. Thanks for everything you do.

Fantastic blogpost with some VERY valid points - I was a doctor until about 10 years ago so can see both sides in terms of doctors rounds so pleased to see you asking doctors to avoid mealtimes "when they can" but can imagine most are oblivious to the issues . Another vote for having this published somewhere national and should be compulsory reading for all new and current doctors - and patients and their relatives.

I remember being an orderly in a home for the elderly, where one family essentially moved in and took care of their dying mother/mother-in-law/granny. They fed her, kept her company, and looked after her hygiene for the last week or so, and then apologised for creating extra dishwashing for me... I would have gladly washed ten times as many dishes for that help. The amount of work and guilty conscience this took off me is indescribable.

What a post! I can tell you, that the situation not far from the one in Danish hospitals. I am a student in journalism and am at the moment trying to write a story about why we don't have protected mealtimes in Denmark. What I've gotten as an answer so far is, that there is no scientific evidence, that the protected mealtimes actually make the malnourished patients intake increase... so my question is, if you by incident know of any scientific research done on protected mealtimes and the results of it, that I can show these people? Or maybe one of you who read this blog?

Can I add yet another voice to say please seriously consider (sans the swearing) sending this to the media? It's hard to read this and not be supportive.

(Although as a side note every hospital I've been in the nurses haven't been made to join ward rounds when busy and they definitely didn't happen during mealtimes, so don't know if this is more of a local issue.)

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.